Why does it feel like there's a pebble in my shoe?
People almost always describe it the same way: a pebble under the ball of the foot, or a sock bunched up that is not there. The shoe comes off, the foot gets rubbed, and it eases. That description, more than any scan, is what points to a Morton’s neuroma.
What is actually going on
The nerves that carry feeling to the toes run between the long bones of the foot, underneath a tight ligament that joins them. Where a nerve is squeezed there, over and over, its sheath thickens and scars. That thickening is the “neuroma”.
Despite the name it is not a tumour, it does not spread, and it does not turn into anything else. It is a normal nerve that has been pinched for long enough to swell — which is why the treatment is about taking the pressure off it.
The symptoms that go with it
Burning, sharp or electric pain under the ball of the foot, running into two toes.
Tingling or numbness in those same toes.
Worse in narrow or heeled shoes and with walking; eased by taking the shoe off and rubbing the foot.
Symptoms that come and go over months, gradually becoming more frequent.
It most often affects the nerve between the third and fourth toes, next most often between the second and third. It is far more common in women, largely because narrow shoes and heels push the bones of the forefoot together and load the front of the foot.
What else causes pain in the ball of the foot
This matters, because several conditions feel similar and are treated quite differently. A tear of the plantar plate — the ligament under the second toe joint — causes pain in the joint itself, often with the toe starting to lift or drift, and is frequently mislabelled as a neuroma. Inflammation of the joint lining, a stress fracture in one of the long bones, a bursa between the bones, and simple thinning of the fat pad under the forefoot all cause pain in the same area. Sorting these out is most of what the consultation is for; an ultrasound usually settles it.
What to change first
A neuroma that has been there a few months, in a foot that has been living in narrow shoes, often settles a long way with two changes:
Wider, lower shoes. Room across the ball of the foot, and a heel height that keeps your weight off the forefoot. This is not a small adjustment — for many people it is the treatment.
A metatarsal dome. A small pad that sits just behind the sore spot and spreads the bones apart, taking the squeeze off the nerve. Inexpensive, and worth a proper trial before anything else.
A neuroma that has been present for years and is large on ultrasound is less likely to settle with these alone, but they are still where treatment starts.
Injections, and what they tell you
A cortisone injection can give relief lasting anywhere from a few weeks to a year or more, and for some people one is all they ever need. It also carries useful information: if the injection helped and then wore off, that confirms the nerve is the source of the pain. If a first injection gave only brief relief, a second is unlikely to do better, and that is the point at which surgery is worth discussing.
The trade-off with surgery
Surgery for a neuroma is reliable for pain, and it is worth going in knowing what it costs. The neuroma is reached through a small incision on the top of the foot, between the long bones, and the thickened section of nerve is removed. That leaves permanent numbness on the facing sides of the two toes and the skin between them. Most people find that a straightforward trade for getting rid of the pain, but it is not reversible, and it is the part to be clear about before you agree to an operation rather than after.
Key points
The feeling of a pebble or bunched sock under the ball of the foot is the classic description.
A neuroma is a pinched, thickened nerve — not a tumour.
Several other conditions mimic it, in particular a plantar plate tear; an ultrasound usually sorts it out.
Wider shoes and a metatarsal dome settle a good proportion of cases.
Surgery works well for pain but leaves permanent numbness between the two toes.
More detail. Want the full picture before your appointment? Morton’s Neuroma covers assessment, injection, surgery and what recovery involves.
Ready to discuss your treatment options?
Book a consultation with Dr Janan Chandrananth to confirm the diagnosis and talk through what is worth trying first.
